Check with your healthcare provider: you and your family may need routine as well as recommended vaccinations.

Before travel, be sure you and your children are up to date on all routine immunizations according to schedules approved by the Advisory Committee on Immunization Practice (ACIP). See the schedule for adults and the schedule for infants and children. Some schedules can be accelerated for travel.

See your doctor at least 4?6 weeks before your trip to allow time for shots to take effect. If it is less than 4 weeks before you leave, you should still see your doctor. It might not be too late to get your shots or medications as well as other information about how to protect yourself from illness and injury while traveling.

Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to East Africa. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

* Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.

* Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11?12 years who did not receive the series as infants.

* Malaria: your risk of malaria may be high in all countries in East Africa, including cities. See your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications, see Malaria Information for Travelers to East Africa.

* Meningococcal (meningitis) if you plan to visit countries in this region that experience epidemics of meningococcal disease during December through June, (see see Map 4-9 on the Meningoccocal Disease page).

* Rabies, pre-exposure vaccination, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.

* Typhoid vaccine. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors

* Yellow fever, a viral disease that occurs primarily in sub-Saharan Africa and tropical South America, is transmitted to humans through the bite of infected mosquitoes. The virus is also present in Panama and Trinidad and Tobago. Yellow fever vaccination is recommended for travelers to endemic areas and may be required to cross certain international borders

Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.

* As needed, booster doses for tetanus-diphtheria, measles, and a one-time dose of polio vaccine for adults.

Required Vaccinations

Sources:

http://www.cdc.gov/travel/,

A certificate of yellow fever vaccination may be required for entry into certain countries in East Africa. For detailed information, see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country. Also, find the nearest authorized U.S. yellow fever vaccine center.

Diseases Found in East Africa

Sources:

http://www.cdc.gov/travel/,

Malaria

Malaria is always a serious disease and may be a deadly illness.

Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in all countries in East Africa, including cities. All travelers to East Africa, including infants, children, and former residents of East Africa, may be at risk for malaria. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below). All travelers should take one of the following drugs:

* atovaquone/proguanil,

* doxycycline,

* mefloquine, or

* primaquine (in special circumstances).

Yellow Fever

A certificate of yellow fever vaccination may be required for entry into certain countries in East Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements. Also, find the nearest authorized U.S. yellow fever vaccine center.

Food and Waterborne Diseases

Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated.

Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers? diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout East Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage ( hepatitis).

Other Disease Risks

Dengue, filariasis, leishmaniasis, onchocerciasis (river blindness) and Rift Valley fever are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. African sleeping sickness (African trypanosomiasis), which is transmitted through the bite of an infected tsetse fly, can be found in distinct areas of East Africa except Djibouti, Eritrea, Somalia, and the island countries of the Atlantic and Indian Oceans. The number of cases of African sleeping sickness in travelers, primarily to East African game parks, has increased in recent years. A number of rickettsial infections also occur in this region. Wearing protective clothing and avoiding rural areas or areas of dense vegetation along streams, is the best protection. Schistosomiasis, a parasitic infection, is found in fresh water in the region, including Lake Malawi. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries. (For more information, please see Swimming and Recreational Water Precautions.) Polio has also resurfaced in Ethiopia since 2003. Other infections that tend to occur more often in longer-term travelers (or immigrants from the region) include tuberculosis, HIV and hepatitis B.

Other Health Risks

Sources:

http://www.cdc.gov/travel/,

Injuries

Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver.

* Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

* Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.

* Iodine tablets and portable water filters to purify water if bottled water is not available. See Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water for more detailed information.

* Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information.

* Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you.

* Always carry medications in their original containers, in your carry-on luggage.

* Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea. See suggested over-the-counter medications and first aid items for a travel kit.

* New security measures were implemented on August 10, 2006, regarding what passengers may carry onto the airplane. Up-to-date information may be obtained at the Transportation Security Administration's Guidance For Airline Passengers Fact Sheet and Frequently Asked Questions.

Staying Healthy During Your Trip

Sources:

http://www.cdc.gov/travel/,

Travelers should take the following precautions to stay healthy:

* When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears.

* Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.

* In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.

* To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches.

* Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

* Protect yourself from mosquito insect bites:

o Wear long-sleeved shirts, long pants, and hats when outdoors.

o Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site.

o If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.

o If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site.

Do not

* Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).

* Do not drink beverages with ice.

* Avoid dairy products, unless you know they have been pasteurized.

* Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis. (For more information, please see Swimming and Recreational Water Precautions.)

* Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas. For more information, please see Animal-Associated Hazards.

* Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

* Avoid poultry farms, bird markets, and other places where live poultry is raised or kept.

After You Return Home

Sources:

http://www.cdc.gov/travel/,

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or seven days (atovaquone/proguanil) after leaving the risk area.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell your health care provider your travel history.

Safety Precautions

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As when visiting any country, travelers should exercise caution and avoid crime like pick-pocketing or mugging by paying attention to surroundings and keeping an eye on personal belongings. Always keep travel documents in a safe place. If you are traveling or moving to a country for more than a few weeks, it is a good idea to register yourself with your embassy in that country and provide emergency contact information.